The JMPT is the premier scientific journal of the chiropractic profession, dedicated to the advancement of chiropractic health care.
Predictors of Functional Trunk Capacity in Older Adults With and Without LBP
Élizabeth Ledoux, MSc, et al.
Objective: The purpose of this study was to determine the physical and psychosocial predictors of functional trunk capacity in a group of healthy elderly individuals and a group of elderly patients with chronic low back pain (LBP).
Methods: The study was done in Canada and included 61 community-dwelling elderly individuals (29 patients with nonspecific chronic LBP and 32 healthy participants) who performed maximal trunk endurance and force tasks. Participants completed various psychologic and functional questionnaires. Sequential linear regression analyses were performed with functional capacity results (endurance and force) as dependent variables and questionnaire scores as independent variables.
Results: Endurance time and peak force were significantly lower in patients compared with healthy elderly individuals (all P values < .001), whereas pain-related fear of movement, pain catastrophizing, and depression levels were higher in patients than their healthy counterpart (all P values < .001). After adjusting for physical activity and disability levels (R2 = 33.7%-50.5% in patients; R2 = 0.1%-5.7% in healthy individuals), none of the psychologic questionnaire could explain variations observed in functional capacity in patients (R2 changes, 4.8%-6.7%) and in healthy participants (R2 changes, 5.2%-10.6%).
Conclusion: Patients showed diminished functional capacity compared with healthy participants. Moreover, physical activity levels represent the most important predictors of functional capacity in elderly patients with LBP.
Altered Trapezius Muscle Behavior in Subjects With Neck Pain, Scapular Dysfunction
Evgeniya Zakharova-Luneva, BPhty (Hons), et al.
Objective: The purpose of this study was to compare the behavior of the trapezius muscle in patients with chronic mechanical neck pain (MNP) and clinical signs of scapula dysfunction to healthy controls.
Methods: This is a cross-sectional, between-participant study of trapezius muscle behavior. Eighteen volunteers with chronic MNP and 20 healthy controls participated in the study. Participants performed isometric shoulder abduction, external rotation, and flexion at three intensities of effort (maximum voluntary contraction [MVC], 50% MVC, and 20% MVC). Electromyographic signals were recorded unilaterally from the upper, middle, and lower portions of the trapezius muscle during isometric shoulder contractions.
Results: Significantly greater levels of lower trapezius electromyographic signals were observed in patients with MNP compared with controls for the abduction (P < .027) and external rotation (P < .036) conditions, but not for the flexion condition (P > .392). No differences in activity were observed in the upper (P > .248) or middle (P > .052) portions of trapezius between groups during any of the isometric shoulder girdle conditions.
Conclusions: These findings represent a change in the behavior of the lower trapezius muscle in individuals with MNP who exhibit clinical signs of scapular dysfunction. Clinicians should consider the potential involvement of the axioscapular muscles when assessing patients with chronic neck pain, as retraining scapular function may be required for the successful management of these patients.
Biomechanical Quantification of Pathologic Manipulable Spinal Lesions
Christopher J. Colloca, DC, et al.
Objective: The purposes of this study were to quantify the biomechanical and pathologic consequences of surgically induced spinal lesions, and to determine their response to spinal manipulation (SMT) in an in vivo ovine model.
Methods: Of 24 Merino sheep, six received L5 spondylolytic defects, six received L1 annular lesions, and 12 served as respective controls. Dorsoventral (DV) stiffness was assessed using oscillatory loads (2-12 Hz). Two SMT force-time profiles were administered in each of the groups using a randomized and repeated-measures design. Stiffness and the effect of SMT on the DV motions and multifidus needle electromyographic responses were assessed using a repeated-measures analysis of variance (α = .05). Postmortem histologic analysis and computed tomography validated the presence of lesions.
Results: L5 DV stiffness was significantly increased (40.2%) in the spondylolysis (6.28 N/mm) compared with the L5 control group (4.48 N/mm) (P < 03). Spinal manipulations delivered to the spondylolysis group resulted in less DV vertebral displacement (P < .01) compared with controls. Dorsoventral stiffness of the disc degeneration group was 5.66 N/mm, 94.5% greater than in the L1 control group (2.91 N/mm) (P < .01). One hundred–millisecond SMTs resulted in significantly reduced DV displacements in the disc degeneration group compared with the L1 control group (P < .01). Animals in the disc degeneration group showed a consistent 25% to 30% reduction in needle electromyographic responses to all SMTs.
Conclusions: Quantifiable objective evidence of spinal lesions and their response to SMT were confirmed in this study. Neuromechanical alterations provide novel insights into quantifying manipulable spinal lesions and a means to biomechanically assess SMT outcomes.
Wrist Extensor Musculature and Topographical Pain Sensitivity Maps of the Elbow
Juan Carlos Prados-Frutos, MD, PhD, et al.
Objective: High-density topographical sensitivity maps have been developed to visualize nonuniformity deep-tissue pain sensitivity in, for example, lateral epicondylitis (LE). The aim of this cadaveric study was to determine the anatomical association between the topographical sensitivity maps over the elbow area and wrist extensor musculature.
Methods: A topographical pressure sensitivity map consisting of 12 points forming a 3 × 4 matrix: four points in the superior part, four points in the middle, and four points in the lower part around the lateral epicondyle was marked on a 50-year embalmed cadaver. Color marker pins were inserted into each point. Pins were removed during the process of dissection, but the small holes created by their removal assured accurate relocation.
Results: Progressive dissection revealed that points 1 to 4 (superior line) were placed over the musculotendinous junction and belly of the extensor carpi radialis brevis (ECRB) muscle, points 6 to 8 (middle line) were placed over the musculotendinous junction and belly of the extensor digitorum communis muscle, and points 9 to 12 (inferior line) were located over the musculotendinous junction and belly of the extensor carpi ulnaris muscle. It was also observed that the superficial branch of the radial nerve runs between the belly of the ECRB and extensor digitorum communis muscles.
Conclusions: This study confirmed that anatomical location previously assumed supporting the important wrist extensor muscles, particularly the ECRB, in patients with LE as depicted by pressure pain sensitivity maps. This study also suggests a potential role of the superficial branch of the radial nerve in LE.
Changes in Pelvic Belt Tension During Two Weight-Bearing Functional Tasks
Ashokan Arumugam, MPT, et al.
Objective: The purposes of this study were to evaluate changes in pelvic belt tension during two weight-bearing functional tasks (transition from bipedal to unipedal stance [BUS] and walking) and to evaluate the reliability and the percentage variation for belt tension scores from trial to trial.
Methods: A cross-sectional repeated-measures study was conducted with 10 healthy male participants (mean age, 28.3 ± 8.8 years). Participants performed 10 trials of BUS and walking while wearing a nonelastic pelvic compression belt (PCB) applied distal to the anterior superior iliac spines, with a load cell positioned in the center of the belt. The load cell was calibrated using known weights (1-10 kg) to define the relationship between the applied tension and voltage change (R2 = 0.99). Load cell tension values were recorded in voltage signals and then converted to newtons of force using appropriate conversion values (0.012 V = 10 N). Mean and standard deviation values, intraclass correlation coefficients (ICC 3,1), and percentage standard error of measurements (% SEM) were analyzed for PCB tension recorded during the BUS and walking trials.
Results: The mean tension achieved with a PCB was found to be 41.02 (±4.23) N during BUS and 44.07 (±5.80) N during walking. The trial-to-trial reliability (ICC 3,1) was high (ICC ≥ 0.9), and the variation in PCB tension across 10 trials (% SEM) was 4% or less.
Conclusion: The mean tension achieved during the tasks was 44 N or less. The reliability is high and the variation is low across the trials, which implies that a PCB could be used to produce consistent effects during repetition of the tasks (BUS and walking).
Association of Side of Unilateral Shoulder Pain and Preferred Sleeping Position
Bo Kempf, DC, et al.
Objective: The purpose of this study was to evaluate if there is an association between the side of unilateral shoulder pain and the patient's preferred sleeping position, and if the preferred sleeping position is related to which side of a double bed one lies in.
Methods: In a cross-sectional study, adult patients seeking chiropractic care with unilateral shoulder pain were asked about sleeping position and, if sleeping with a partner, which side of the bed they slept in. A total of 83 participants were included from 10 chiropractic clinics. Associations were cross-tabulated and tested by Fisher exact test.
Results: The pain was in the right shoulder in 55% (95% confidence interval, 46-66) of the participants with unilateral pain. The side of shoulder pain was associated with the side patients slept on, with 67% of those sleeping on one side lying on the painful shoulder (P = .02). Moreover, patients were more likely to turn away from their partner at night, and 76% slept on the side opposite their partner (P < .001).
Conclusions: Patients with unilateral shoulder pain were more likely to sleep on the side of the painful shoulder than on the pain-free side and reported to turn away from their partners in bed. It is unknown whether the observed associations are causal, but it is worth investigating whether a change in sleeping position has a positive effect on patients with shoulder pain and if this can be achieved simply by changing side of sleeping in bed.
Chiropractic Care of Children From Birth to Adolescence
Aurélie M. Marchand, DC, MScACPP
Objective: Few studies have addressed the practice of chiropractic care of children in Europe. No systematic classification of conditions currently exists in chiropractic pediatrics. The objective of this study was to investigate characteristics of clinical chiropractic practice, including the age of pediatric patients, the number of reports of negative side effects (NSEs), the opinions of doctors of chiropractic on treatment options by patient age groups, the conditions seen and the number of treatment sessions delivered by conditions and by patient age.
Methods: An Internet cross-sectional survey was conducted in 20 European countries with 4,109 doctors of chiropractic invited to reply. The 19 national associations belonging to the European Chiropractic Union and the Danish Chiropractic Association were asked to participate. Respondents were asked to self-report characteristics of their practices.
Results: Of the 956 (23.3%) participating chiropractors, 921 reported 19,821 pediatric patients per month. Children represented 8.1% of chiropractors' total patient load over the last year. A total of 557 (534 mild, 23 moderate, and 0 severe) negative (adverse) side effects were reported for an estimated incidence of 0.23%. On the given treatment statements, chiropractors reported varying agreement and disagreement rates based on patient age. The 8,309 answers on conditions were grouped into skeletal (57.0%), neurologic (23.7%), gastrointestinal (12.4%), infection (3.5%), genitourinary (1.5%), immune (1.4%), and miscellaneous conditions (0.5%). The number of treatment sessions delivered varied according to the condition and the patient age.
Conclusion: This study showed that European chiropractors are active in the care of pediatric patients. Reported conditions were mainly skeletal and neurologic complaints. In this survey, no severe NSEs were reported, and mild NSEs were infrequent.
JMPT abstracts appear in DC with permission from the journal. Due to space restrictions, we cannot always print all abstracts from a given issue. Visit www.journals.elsevierhealth.com/periodicals/ymmt for access to the complete June 2012 issue of JMPT.